OBJECTIVES: To evaluate the effectiveness of the care provided to patients with heart failure through the implementation of clinical pathways at the hospital "The Holy Family" in Novafeltria (Italy). METHODS: We performed a pre-post analysis model to evaluate the effect of the application of clinical pathways on process indicators, outcome indicators and on the costs sustained to treat the patients. We compared the results obtained treating the patients according to the clinical pathway with the results obtained before implementing the pathway. We studied quantitative variables with t Student test or Wilcoxon test, qualitative variables with X2 test. RESULTS: Two hundred forty-six cases were included in our study. These subjects were all the patients admitted for hearth failure to the hospital and treated by the staff. We compared the age, the sex and the disease staging (NYHA scores at admission) of the patients of the 2 groups and we did not find any significant difference. After the implementation of the pathway we observed a significant improvement of the core processes. We observed a reduction of the rate unscheduled readmissions within 31 days from discharge (from 6.74% to 2.94%; p>0.05), of the average length of stay (from 10.89days to 7.86; p<0.05) and of inpatients' mortality (from 17.42% to 4.41%; p<0.01). The average costs for patient increased from 2.399 US$ to 2.596 US$ (p>0.05). CONCLUSION: Our primary finding was that the implementation of the clinical pathway for heart failure improved patients' outcomes and the quality of the core processes. Our results also showed that this was possible without incrementing the costs. This study has important limitations too. The initial measurement occurred a year before the full implementation of the pathways. Thus, it is possible that some of the observed improvement represented a natural drift toward higher performance.